Provider Demographics
NPI:1871740084
Name:KELLEHER, COLLEEN MARIE (PT)
Entity type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:MARIE
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13326 ANGELL RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-9616
Mailing Address - Country:US
Mailing Address - Phone:740-594-8781
Mailing Address - Fax:
Practice Address - Street 1:300 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1708
Practice Address - Country:US
Practice Address - Phone:740-385-2155
Practice Address - Fax:740-380-2502
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist